The lack of widespread, no-cost testing with quick result turnarounds is killing the social and economic foundation of our country.
Asymptomatic infections perpetuate the large and steady flow of new cases reported across the nation. Access to testing will provide the hundreds of thousands of infected, yet asymptomatic and contagious, people knowledge of their status. Empowering people with such knowledge gives them the power of choice: to choose their behaviors and their role in reducing the spread of the virus.
Widespread testing is necessary, but not sufficient, to extinguish the COVID-19 wildfire. A multi-layered strategy involving public face-covering, social distancing, and hand hygiene is the only public health tool available at this time. Participating in these strategies, including testing, is a choice. However, testing is limited based on availability. Many communities are experiencing long waiting lines for tests and delays as long as four days to report results. Many locations will only permit people to test if they have symptoms or have been exposed. This defeats the purpose of using testing to detect asymptomatic infections.
The nation reported results of more than 1.5 million tests per day during the month of November. At that rate, every person in the country would be tested once every 30 weeks, a dangerously risky and unacceptably low rate. Testing every person in the country once per week would require more than 45 million tests per day, or more than 30 times the number of tests being run today.
To illustrate the nation’s testing dysfunction, Illinois averaged 90,000 tests per day in November. At this rate, each person in the state would be tested less than three times per year! What is worse is Illinois ranks as the No. 7 highest state for per capita testing. New York ranks No. 4, at around one test per resident since the pandemic began, while Rhode Island ranks No. 1 at around 1.5 tests per resident, still woefully inadequate. These numbers are indicative of the dismal status of testing across the nation.
Frequent testing also neutralizes false negatives. In general, if a person is infected, the test will eventually return positive upon repeat testing, indicating a true infection.
For tests to be most effective, the turnaround time for results must be within hours, not days. The value of a positive test result rapidly diminishes if someone does not isolate while waiting for results. Such delays are symptomatic of the disheartening state of testing in the nation and may also play a role in outbreaks at churches, restaurants, gyms, and other places where people gather indoors (such as holiday events). This is another reason why those at-risk must be particularly cautious at such venues or simply stay away from them altogether.
The lack of widespread testing also contributes to the increased risk associated with attending holiday events. A single test before an event is just one snapshot in time of a person’s infection status. Without a stream of test results, the full picture of a person’s health and their community’s safety is unclear. This is why universities such as Duke and Cornell, which require all students, staff, and faculty to be tested weekly or even more frequently, have seen low numbers of infections. Such surveillance testing is the price to be paid to traverse the road to normalcy for everyone.
President-elect Joe Biden’s COVID-19 seven-point plan promises widespread testing. Unfortunately, this testing capacity will arrive after Inauguration Day, long after holiday festivities have ended. Without necessary precautions, we are likely to see 20 million cases and more than 310,000 deaths by the New Year, as the COVID-19 wildfire continues to spread.
We cannot test our way out of the current COVID-19 crisis. However, without widespread testing availability and rapid results, asymptomatic infections will continue to drive the large number of new infections. Even with a widely available vaccine, testing will continue to be an important public health tool that works to everyone’s advantage.
Sheldon H. Jacobson is a founder professor of computer science at the University of Illinois at Urbana-Champaign, director of the Simulation and Optimization Laboratory, and founding director of the Bed Time Research Institute. Janet A. Jokela, MD, MPH, is the acting regional dean of the University of Illinois College of Medicine at Urbana-Champaign.
